Cevirin S >
The most common side effects of Cevirin treatment for genital herpes include nausea, vomiting, and diarrhea.
Shingles requires treatment with higher doses of Cevirin, and the most common side effects at higher doses are tiredness and malaise.
Tell your doctor if you have any side effects. Side effects that may be seen in all people using Cevirin include:
- Muscle or joint aches
- Visual changes
- Fluid retention
- Hair loss
- Changes in behavior
Serious side effects also can occur. If you have any of these side effects, call your doctor right away:
- Severe rash, hives, or a rash that causes blisters and peeling
- Yellowing of skin or eyes
- Unusual bleeding or bruising
- Loss of consciousness
- Swelling of face, lips, or tongue
- Difficulty breathing
- Decreased urine output or blood in the urine
- Extreme sleepiness or confusion
- Tingling, numbness, or shakiness
Age matters, too. People older than 65 may have more side effects from Cevirin because their kidneys do not get rid of the drug as quickly as younger people's do.
Why it's used
Cevirin is used to treat viral infections. These include varicella-zoster (shingles), genital herpes, and chickenpox.
This drug doesn't cure herpes infections. The herpes virus can stay in your body for a long time and cause symptoms again later.
Which drugs or supplements interact with Cevirin?
Cevirin may decrease levels of phenytoin (Dilantin) or valproic acid (Depakote, Depakote ER). Probenecid (Benemid) may increase Cevirin serum levels by decreasing renal excretion of Cevirin. Cevirin may increase serum levels of theophylline (Theo-Dur, Respbid, Slo-Bid, Theo-24, Theolair, Uniphyl, Slo-Phyllin).
Combining Cevirin with cidofovir (Vistide), amphotericin B (Fungizone) or other drugs that reduce kidney function may increase harmful effects on the kidney.
In one study of 35 immunocompromised patients with herpes simplex or varicella-zoster infection given ZOVIRAX® Capsules in doses of 200 to 1,000 mg every 4 hours, 6 times daily for 5 days, the bioavailability was estimated to be 15 to 20%. In this study, steady-state plasma levels were reached by the second day of dosing. Mean steady-state peak and trough concentrations following the last 200 mg dose were 0.49 μg/mL (0.47 to 0.54 μg/mL) and 0.31 μg/mL (0.18 to 0.41 μg/mL), respectively and following the last 800 mg dose were 2.8 μg/mL (2.3 to 3.1 μg/mL) and 1.8 μg/mL (1.3 to 2.5 μg/mL). In another study, 20 immunocompetent patients with recurrent genital herpes simplex infections given ZOVIRAX® Capsules in dose of 800 mg every 6 hours, 4 times daily for 5 days, the mean steady-state peak and trough concentrations were 1.4 μg/mL (0.66 to 1.8 μg/mL) and 0.55 μg/mL (0.14 to 1.1 μg/mL).
In a multiple-dose crossover study where 23 volunteers received ZOVIRAX® as one 200 mg capsule, one 400 mg tablet and one 800 mg tablet 6 times daily, absorption decreased with increasing dose and the estimated bioavailabilities of Cevirin were 20, 15 and 10%, respectively. The decrease in bioavailability is believed to be a function of the dose and not the dosage form. It was demonstrated that Cevirin is not dose proportional over the dosing range 200 to 800 mg. In this study, steady-state peak and trough concentrations of Cevirin were 0.83 and 0.46 μg/mL, 1.21 and 0.63 μg/mL, and 1.61 and 0.83 μg/mL for the 200, 400 and 800 mg dosage regimens, respectively.
In another study in 6 volunteers, the influence of food on the absorption of Cevirin was not apparent.
A single oral dose bioavailability study in 23 normal volunteers showed that ZOVIRAX® Capsules 200 mg are bioequivalent to 200 mg Cevirin in aqueous solution. In a separate study in 20 volunteers, it was shown that ZOVIRAX® Suspension is bioequivalent to ZOVIRAX® Capsules. In a different single-dose bioavailability/ bioequivalence study in 24 volunteers, one ZOVIRAX® 800 mg Tablet was demonstrated to be bioequivalent to four ZOVIRAX® 200 mg Capsules.
Cevirin can cause a severe allergic reaction. Symptoms can include:
- trouble breathing
- swelling of your throat or tongue
Call 911 or go to the nearest emergency room if you develop these symptoms. Don't take this drug again if you've ever had an allergic reaction to it. Taking it again could be fatal (cause death).
For patients who require hemodialysis, the mean plasma half-life of Cevirin during hemodialysis is approximately 5 hours. This results in a 60% decrease in plasma concentrations following a six-hour dialysis period. Therefore, the patient's dosing schedule should be adjusted so that an additional dose is administered after each dialysis.
- Take this drug at the time(s) recommended by your doctor.
- You can take Cevirin with or without food. Taking it with food may help reduce upset stomach.
- Do not cut or crush this medication.
- Not every pharmacy stocks this drug. When filling your prescription, be sure to call ahead to make sure your pharmacy carries it.
Drug-drug. Interferon: additive effect
Nephrotoxic drugs: increased risk of nephrotoxicity
Probenecid: increased Cevirin blood level
Zidovudine: increased CNS effects, especially drowsiness
Drug-diagnostic tests. Alanine aminotransferase, aspartate aminotransferase, bilirubin, blood urea nitrogen: increased levels
Patients are instructed to consult with their physician if they experience severe or troublesome adverse reactions, they become pregnant or intend to become pregnant, they intend to breastfeed while taking orally administered ZOVIRAX (Cevirin) , or they have any other questions.
Patients should be advised to maintain adequate hydration.
Of 376 subjects who received ZOVIRAX (Cevirin) in a clinical study of herpes zoster treatment in immunocompetent subjects ¡Ý50 years of age, 244 were 65 and over while 111 were 75 and over. No overall differences in effectiveness for time to cessation of new lesion formation or time to healing were reported between geriatric subjects and younger adult subjects. The duration of pain after healing was longer in patients 65 and over. Nausea, vomiting, and dizziness were reported more frequently in elderly subjects. Elderly patients are more likely to have reduced renal function and require dose reduction. Elderly patients are also more likely to have renal or CNS adverse events. With respect to CNS adverse events observed during clinical practice, somnolence, hallucinations, confusion, and coma were reported more frequently in elderly patients (see CLINICAL PHARMACOLOGY, ADVERSE REACTIONS: Observed During Clinical Practice, and DOSAGE AND ADMINISTRATION).
Q: What is Cevirin used for?
A: Cevirin (Zovirax) is an antiviral medication that can be used in the treatment of the herpes virus, including genital herpes, cold sores, and shingles. Cevirin can also be used to help with the chicken pox virus. The most frequently reported adverse reactions differed among clinical trials of Cevirin depending on the indication for use. During clinical trials of treatment with Cevirin, the most frequently reported adverse reactions included nausea, vomiting, diarrhea, malaise and headache. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Kristen Dore, PharmD
By Chris Iliades, MD | Medically Reviewed by Niya Jones, MD, MPH
Latest Update: 2014-04-28 Copyright © 2014 Everyday Health Media, LLC
Other Cevirin Interactions
You do not need to change your diet or your activities while on Cevirin.
However, drink plenty of fluids when taking this medication.
What are the side effects of Cevirin?
The most common side effects are
Other reported side effects include:
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Q: Can Cevirin cause uncontrollable muscle twitching?
A: Cevirin (Zovirax) //www.everydayhealth.com/drugs/Cevirin is a medication used to treat viral infections. The most common side effects associated with the oral form of Cevirin are diarrhea, nausea, vomiting, headache, and feeling tired (malaise). Cevirin cream and ointment can cause skin irritation. A search of the prescribing information for Cevirin did not specifically list uncontrollable muscle twitching as a side effect. Tell your health-care provider about any negative side effects from prescription drugs. You can also report them to the U.S. Food and Drug Administration by visiting www.fda.gov/medwatch or by calling 1-800-FDA-1088. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Lori Mendoza, PharmD
Q: I am in stage 1 of multiple myeloma. I was diagnosed nearly 3 years ago. The last 3 summers I have had attacks of shingles, the 1st year I took 1000 mg of Cevirin daily and avoided the painful stage. Last year I missed the spots as they were on my back and suffered greatly for 2 to 3 months and I am still taking 1000 mg Cevirin per day. Each time I stop the medication the fever returns for a couple of days followed by the first few spots. I am on my 5th lot of Cevirin, starting with 1000 mg per day, increasing to 2,400 per day and 2 weeks ago was prescribed 4000 mg per day for 21 days. I have managed 10 days at this level but there are so many side effects, including kidney pain, so I have reduced to 3 tablets of 800 mg each. I feel less "in a fog" and slightly better already but am afraid when I stop the shingles will return. I am concerned about the side effects. Can you give me advice please? The side effects are basically 90% of the ones mentioned on the leaflet in the box of 800 mg tablets at 5 per day.
A: Shingles is a painful rash that is caused by the same virus (varicella virus) that causes the chickenpox. Only people who were infected with the virus and got chickenpox can get shingles. Unfortunately, people with weakened immune systems, from other diseases like cancer or treatments like chemotherapy, are at much greater risk of developing shingles. Drugs like Cevirin (Zovirax) work to reduce the ability of the virus to multiply and spread in the body. Cevirin has been shown to reduce the duration of infection and the severity of symptoms, but it relies on an individual's immune system to attack the virus. The drug itself does not kill the virus and that is likely the reason you continue to have symptoms and relapses. It is possible that some of the painful effects you are experiencing are the result of complications of shingles. One of these complications is called postherpetic neuralgia, which is the painful, tingling, and stinging pain at the site of the initial rash. There are medications that are used to help treat the pain associated with the nerve damage of shingles. These drugs include the anticonvulsants, such as Neurontin (gabapentin), Lyrica (pregabalin), and Tegretol (carbamazepine) and tricyclic antidepressants like Elavil (amitriptyline). For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Michelle McDermott, PharmD
Is Cevirin safe to take if I'm pregnant or breastfeeding?
There are no adequate studies of Cevirin in pregnant women. In a patient registry of women who used Cevirin during the first trimester, the rate of birth defects was similar to the rate of birth defects in the general population.
Cevirin is excreted in breast milk, and a significant amount may be transferred to the infant.
Carcinogenesis, Mutagenesis, Impairment of Fertility
The data presented below include references to peak steady-state plasma Cevirin concentrations observed in humans treated with 800 mg given orally 5 times a day (dosing appropriate for treatment of herpes zoster) or 200 mg given orally 5 times a day (dosing appropriate for treatment of genital herpes). Plasma drug concentrations in animal studies are expressed as multiples of human exposure to Cevirin at the higher and lower dosing schedules (see CLINICAL PHARMACOLOGY: Pharmacokinetics).
Cevirin was tested in lifetime bioassays in rats and mice at single daily doses of up to 450 mg/kg administered by gavage. There was no statistically significant difference in the incidence of tumors between treated and control animals, nor did Cevirin shorten the latency of tumors. Maximum plasma concentrations were 3 to 6 times human levels in the mouse bioassay and 1 to 2 times human levels in the rat bioassay.
Cevirin was tested in 16 in vitro and in vivo genetic toxicity assays. Cevirin was positive in 5 of the assays.
Cevirin did not impair fertility or reproduction in mice (450 mg/kg/day, p.o.) or in rats (25 mg/kg/day, s.c.). In the mouse study, plasma levels were 9 to 18 times human levels, while in the rat study, they were 8 to 15 times human levels. At higher doses (50 mg/kg/day, s.c.) in rats and rabbits (11 to 22 and 16 to 31 times human levels, respectively) implantation efficacy, but not litter size, was decreased. In a rat peri- and post-natal study at 50 mg/kg/day, s.c., there was a statistically significant decrease in group mean numbers of corpora lutea, total implantation sites, and live fetuses.
No testicular abnormalities were seen in dogs given 50 mg/kg/day, IV for 1 month (21 to 41 times human levels) or in dogs given 60 mg/kg/day orally for 1 year (6 to 12 times human levels). Testicular atrophy and aspermatogenesis were observed in rats and dogs at higher dose levels.
Cevirin can make your skin more sensitive to the sun. This increases your risk of sunburn. Avoid the sun if you can. If you can't, be sure to wear protective clothing and apply sunscreen.